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Wang J, de Vale JS, Gupta S, Upadhyaya P, Lisboa FA, Schobel SA, Elster EA, Dente CJ, Buchman TG, Kamaleswaran R. ClotCatcher: a novel natural language model to accurately adjudicate venous thromboembolism from radiology reports. BMC Med Inform Decis Mak 2023; 23:262. [PMID: 37974186 PMCID: PMC10652606 DOI: 10.1186/s12911-023-02369-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION Accurate identification of venous thromboembolism (VTE) is critical to develop replicable epidemiological studies and rigorous predictions models. Traditionally, VTE studies have relied on international classification of diseases (ICD) codes which are inaccurate - leading to misclassification bias. Here, we developed ClotCatcher, a novel deep learning model that uses natural language processing to detect VTE from radiology reports. METHODS Radiology reports to detect VTE were obtained from patients admitted to Emory University Hospital (EUH) and Grady Memorial Hospital (GMH). Data augmentation was performed using the Google PEGASUS paraphraser. This data was then used to fine-tune ClotCatcher, a novel deep learning model. ClotCatcher was validated on both the EUH dataset alone and GMH dataset alone. RESULTS The dataset contained 1358 studies from EUH and 915 studies from GMH (n = 2273). The dataset contained 1506 ultrasound studies with 528 (35.1%) studies positive for VTE, and 767 CT studies with 91 (11.9%) positive for VTE. When validated on the EUH dataset, ClotCatcher performed best (AUC = 0.980) when trained on both EUH and GMH dataset without paraphrasing. When validated on the GMH dataset, ClotCatcher performed best (AUC = 0.995) when trained on both EUH and GMH dataset with paraphrasing. CONCLUSION ClotCatcher, a novel deep learning model with data augmentation rapidly and accurately adjudicated the presence of VTE from radiology reports. Applying ClotCatcher to large databases would allow for rapid and accurate adjudication of incident VTE. This would reduce misclassification bias and form the foundation for future studies to estimate individual risk for patient to develop incident VTE.
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Affiliation(s)
- Jeffrey Wang
- Department of Biomedical Informatics, Emory University School of Medicine, 1462 Clifton Road, Suite 504, Atlanta, GA, 30322, USA.
| | - Joao Souza de Vale
- Department of Biomedical Informatics, Emory University School of Medicine, 1462 Clifton Road, Suite 504, Atlanta, GA, 30322, USA
| | - Saransh Gupta
- Department of Biomedical Informatics, Emory University School of Medicine, 1462 Clifton Road, Suite 504, Atlanta, GA, 30322, USA
| | - Pulakesh Upadhyaya
- Department of Biomedical Informatics, Emory University School of Medicine, 1462 Clifton Road, Suite 504, Atlanta, GA, 30322, USA
| | - Felipe A Lisboa
- Surgical Critical Care Initiative (SC2i), Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD, 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, 20817, USA
| | - Seth A Schobel
- Surgical Critical Care Initiative (SC2i), Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD, 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, 20817, USA
| | - Eric A Elster
- Surgical Critical Care Initiative (SC2i), Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD, 20814, USA
| | - Christopher J Dente
- Surgical Critical Care Initiative (SC2i), Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
- Emory Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
| | - Timothy G Buchman
- Surgical Critical Care Initiative (SC2i), Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
- Emory Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
- Emory Critical Care Center, Atlanta, GA, USA
| | - Rishikesan Kamaleswaran
- Department of Biomedical Informatics, Emory University School of Medicine, 1462 Clifton Road, Suite 504, Atlanta, GA, 30322, USA
- Surgical Critical Care Initiative (SC2i), Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
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KHREBTIY Y, CHERNUKHA L. Aspiration rotational thrombectomy in treatment of pulmonary embolism. ACTA PHLEBOLOGICA 2023. [DOI: 10.23736/s1593-232x.22.00552-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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Wu H, Wang M, Wu J, Francis F, Chang YH, Shavick A, Dong H, Poon MTC, Fitzpatrick N, Levine AP, Slater LT, Handy A, Karwath A, Gkoutos GV, Chelala C, Shah AD, Stewart R, Collier N, Alex B, Whiteley W, Sudlow C, Roberts A, Dobson RJB. A survey on clinical natural language processing in the United Kingdom from 2007 to 2022. NPJ Digit Med 2022; 5:186. [PMID: 36544046 PMCID: PMC9770568 DOI: 10.1038/s41746-022-00730-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Much of the knowledge and information needed for enabling high-quality clinical research is stored in free-text format. Natural language processing (NLP) has been used to extract information from these sources at scale for several decades. This paper aims to present a comprehensive review of clinical NLP for the past 15 years in the UK to identify the community, depict its evolution, analyse methodologies and applications, and identify the main barriers. We collect a dataset of clinical NLP projects (n = 94; £ = 41.97 m) funded by UK funders or the European Union's funding programmes. Additionally, we extract details on 9 funders, 137 organisations, 139 persons and 431 research papers. Networks are created from timestamped data interlinking all entities, and network analysis is subsequently applied to generate insights. 431 publications are identified as part of a literature review, of which 107 are eligible for final analysis. Results show, not surprisingly, clinical NLP in the UK has increased substantially in the last 15 years: the total budget in the period of 2019-2022 was 80 times that of 2007-2010. However, the effort is required to deepen areas such as disease (sub-)phenotyping and broaden application domains. There is also a need to improve links between academia and industry and enable deployments in real-world settings for the realisation of clinical NLP's great potential in care delivery. The major barriers include research and development access to hospital data, lack of capable computational resources in the right places, the scarcity of labelled data and barriers to sharing of pretrained models.
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Affiliation(s)
- Honghan Wu
- Institute of Health Informatics, University College London, London, UK.
| | - Minhong Wang
- Institute of Health Informatics, University College London, London, UK
| | - Jinge Wu
- Institute of Health Informatics, University College London, London, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Farah Francis
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Yun-Hsuan Chang
- Institute of Health Informatics, University College London, London, UK
| | - Alex Shavick
- Research Department of Pathology, UCL Cancer Institute, University College London, London, UK
| | - Hang Dong
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Department of Computer Science, University of Oxford, Oxford, UK
| | | | | | - Adam P Levine
- Research Department of Pathology, UCL Cancer Institute, University College London, London, UK
| | - Luke T Slater
- Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK
| | - Alex Handy
- Institute of Health Informatics, University College London, London, UK
- University College London Hospitals NHS Trust, London, UK
| | - Andreas Karwath
- Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK
| | - Georgios V Gkoutos
- Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK
| | - Claude Chelala
- Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Anoop Dinesh Shah
- Institute of Health Informatics, University College London, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Nigel Collier
- Theoretical and Applied Linguistics, Faculty of Modern & Medieval Languages & Linguistics, University of Cambridge, Cambridge, UK
| | - Beatrice Alex
- Edinburgh Futures Institute, University of Edinburgh, Edinburgh, UK
| | | | - Cathie Sudlow
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Angus Roberts
- Department of Biostatistics & Health Informatics, King's College London, London, UK
| | - Richard J B Dobson
- Institute of Health Informatics, University College London, London, UK
- Department of Biostatistics & Health Informatics, King's College London, London, UK
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Woller IA, Woller SC, Stevens SM, Lloyd JF, Conner KE, Gordon BH, Snow GL, Jones P, Bledsoe JR. Synoptic reporting accuracy for computed tomography pulmonary arteriography among patients suspected of pulmonary embolism. J Am Coll Emerg Physicians Open 2022; 3:e12801. [PMID: 36226236 PMCID: PMC9530339 DOI: 10.1002/emp2.12801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 07/08/2022] [Accepted: 07/21/2022] [Indexed: 11/06/2022] Open
Abstract
Background Structured reporting is an efficient and replicable method of presenting diagnostic results that eliminates variability inherent in narrative descriptive reporting and may improve clinical decisions. Synoptic element reporting can generate discrete coded data that then may inform clinical decision support and trigger downstream actions in computerized electronic health records. Objective Limited evidence exists for use of synoptic reporting for computed tomography pulmonary arteriography (CTPA) among patients suspected of pulmonary embolism. We reported the accuracy of synoptic reporting for the outcome of pulmonary embolism among patients who presented to an integrated health care system with CTPA performed for suspected pulmonary embolism. Methods Structured radiology reports with embedded synoptic elements were implemented for all CTPA examinations on March 1, 2018. Four hundred CTPA reports between January 4, 2019 and July 30, 2020 (200 reports each for which synoptic reporting recorded the presence or absence of pulmonary embolism [PE]) were selected at random. One non-diagnostic study was excluded from analysis. We then assessed the accuracy of synoptic reporting compared with the gold standard of manual chart review. Results Synoptic reporting and manual review agreed in 99.2% of patients undergoing CTPA for suspected PE, agreed on the presence of PE in 196 of 199 (98.5%) cases, the absence of PE in 200 of 200 (100%) cases with a sensitivity of 87.6% (76.1-96.1) a specificity of 99.9% (99.7%-100%), a positive predictive value of 99.5% (98.1-100), and a negative predictive value of 98% (95.7%-99.5%). Conclusion The overall rate of agreement was 99.2%, but we observed an unacceptable false-negative rate for clinical reliance on synoptic element reporting in isolation from dictated reports.
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Affiliation(s)
| | - Scott C. Woller
- Department of MedicineIntermountain Medical Center and Department of Internal MedicineUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Scott M. Stevens
- Department of MedicineIntermountain Medical Center and Department of Internal MedicineUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - James F. Lloyd
- Department of Medical InformaticsIntermountain HealthcareSalt Lake CityUtahUSA
| | - Karen E. Conner
- Department of RadiologyIntermountain Medical CenterSalt Lake CityUtahUSA
| | - Benjamin H. Gordon
- Department of RadiologyIntermountain Medical CenterSalt Lake CityUtahUSA
| | - Greg L. Snow
- Office of ResearchIntermountain HealthcareStatistical Data CenterSalt Lake CityUtahUSA
| | - Peter Jones
- Intermountain HealthcareEnterprise AnalyticsSalt Lake CityUtahUSA
| | - Joseph R. Bledsoe
- Department of Emergency Medicine Intermountain HealthcareSalt Lake CityUtahUSA,Department of Emergency MedicineStanford MedicinePalo AltoCaliforniaUSA
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Jin ZG, Zhang H, Tai MH, Yang Y, Yao Y, Guo YT. Natural Language Processing for Identification of Venous Thromboembolism in a Clinical Decision Support System: Validation Study (Preprint). J Med Internet Res 2022; 25:e43153. [PMID: 37093636 PMCID: PMC10167583 DOI: 10.2196/43153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/20/2022] [Accepted: 03/29/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND It remains unknown whether capturing data from electronic health records (EHRs) using natural language processing (NLP) can improve venous thromboembolism (VTE) detection in different clinical settings. OBJECTIVE The aim of this study was to validate the NLP algorithm in a clinical decision support system for VTE risk assessment and integrated care (DeVTEcare) to identify VTEs from EHRs. METHODS All inpatients aged ≥18 years in the Sixth Medical Center of the Chinese People's Liberation Army General Hospital from January 1 to December 31, 2021, were included as the validation cohort. The sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-, respectively), area under the receiver operating characteristic curve (AUC), and F1-scores along with their 95% CIs were used to analyze the performance of the NLP tool, with manual review of medical records as the reference standard for detecting deep vein thrombosis (DVT) and pulmonary embolism (PE). The primary end point was the performance of the NLP approach embedded into the EHR for VTE identification. The secondary end points were the performances to identify VTE among different hospital departments with different VTE risks. Subgroup analyses were performed among age, sex, and the study season. RESULTS Among 30,152 patients (median age 56 [IQR 41-67] years; 14,247/30,152, 47.3% females), the prevalence of VTE, PE, and DVT was 2.1% (626/30,152), 0.6% (177/30,152), and 1.8% (532/30,152), respectively. The sensitivity, specificity, LR+, LR-, AUC, and F1-score of NLP-facilitated VTE detection were 89.9% (95% CI 87.3%-92.2%), 99.8% (95% CI 99.8%-99.9%), 483 (95% CI 370-629), 0.10 (95% CI 0.08-0.13), 0.95 (95% CI 0.94-0.96), and 0.90 (95% CI 0.90-0.91), respectively. Among departments of surgery, internal medicine, and intensive care units, the highest specificity (100% vs 99.7% vs 98.8%, respectively), LR+ (3202 vs 321 vs 77, respectively), and F1-score (0.95 vs 0.89 vs 0.92, respectively) were in the surgery department (all P<.001). Among low, intermediate, and high VTE risks in hospital departments, the low-risk department had the highest AUC (1.00 vs 0.94 vs 0.96, respectively) and F1-score (0.97 vs 0.90 vs 0.90, respectively) as well as the lowest LR- (0.00 vs 0.13 vs 0.08, respectively) (DeLong test for AUC; all P<.001). Subgroup analysis of the age, sex, and season demonstrated consistently good performance of VTE detection with >87% sensitivity and specificity and >89% AUC and F1-score. The NLP algorithm performed better among patients aged ≤65 years than among those aged >65 years (F1-score 0.93 vs 0.89, respectively; P<.001). CONCLUSIONS The NLP algorithm in our DeVTEcare identified VTE well across different clinical settings, especially in patients in surgery units, departments with low-risk VTE, and patients aged ≤65 years. This algorithm can help to inform accurate in-hospital VTE rates and enhance risk-classified VTE integrated care in future research.
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Affiliation(s)
- Zhi-Geng Jin
- Department of Pulmonary Vascular and Thrombotic Disease, Sixth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hui Zhang
- Department of Pulmonary Vascular and Thrombotic Disease, Sixth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Mei-Hui Tai
- Chinese People's Liberation Army Medical School, Beijing, China
| | - Ying Yang
- Quality Management Division, Sixth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yuan Yao
- Institute for Hospital Management Research, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yu-Tao Guo
- Department of Pulmonary Vascular and Thrombotic Disease, Sixth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
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Woller SC, Stevens SM, Bledsoe JR, Fazili M, Lloyd JF, Snow GL, Horne BD. Biomarker derived risk scores predict venous thromboembolism and major bleeding among patients with COVID-19. Res Pract Thromb Haemost 2022; 6:e12765. [PMID: 35873221 PMCID: PMC9301476 DOI: 10.1002/rth2.12765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/21/2022] [Accepted: 06/19/2022] [Indexed: 12/15/2022] Open
Abstract
Background Venous thromboembolism (VTE) risk is increased in patients with COVID‐19 infection. Understanding which patients are likely to develop VTE may inform pharmacologic VTE prophylaxis decision making. The hospital‐associated venous thromboembolism–Intermountain Risk Score (HA‐VTE IMRS) and the hospital‐associated major bleeding–Intermountain Risk Score (HA‐MB IMRS) are risk scores predictive of VTE and bleeding that were derived from only patient age and data found in the complete blood count (CBC) and basic metabolic panel (BMP). Objectives We assessed the HA‐VTE IMRS and HA‐MB IMRS for predictiveness of 90‐day VTE and major bleeding, respectively, among patients diagnosed with COVID‐19, and further investigated if adding D‐dimer improved these predictions. We also reported 30‐day outcomes. Patients/Methods We identified 5047 sequential patients with a laboratory confirmed diagnosis of COVID‐19 and a CBC and BMP between 2 days before and 7 days following the diagnosis of COVID‐19 from March 12, 2020, to February 28, 2021. We calculated the HA‐VTE IMRS and the HA‐MB IMRS for all patients. We assessed the added predictiveness of D‐dimer obtained within 48 hours of the COVID test. Results The HA‐VTE IMRS yielded a c‐statistic of 0.70 for predicting 90‐day VTE and adding D‐dimer improved the c‐statistic to 0.764 with the corollary sensitivity/specificity/positive/negative predictive values of 49.4%/75.7%/6.7%/97.7% and 58.8%/76.2%/10.9%/97.4%, respectively. Among hospitalized and ambulatory patients separately, the HA‐VTE IMRS performed similarly. The HA‐MB IMRS predictiveness for 90‐day major bleeding yielded a c‐statistic of 0.64. Conclusion The HA‐VTE IMRS and HA‐MB IMRS predict 90‐ and 30‐day VTE and major bleeding among COVID‐19 patients. Adding D‐dimer improved the predictiveness of the HA‐VTE IMRS for VTE.
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Affiliation(s)
- Scott C Woller
- Department of Medicine Intermountain Medical Center, Intermountain Healthcare Murray Utah USA.,Department of Internal Medicine University of Utah School of Medicine Salt Lake City Utah USA
| | - Scott M Stevens
- Department of Medicine Intermountain Medical Center, Intermountain Healthcare Murray Utah USA.,Department of Internal Medicine University of Utah School of Medicine Salt Lake City Utah USA
| | - Joseph R Bledsoe
- Department of Emergency Medicine, Intermountain Medical Center Intermountain Healthcare Murray Utah USA.,Stanford University Stanford California USA
| | - Masarret Fazili
- Department of Medicine Intermountain Medical Center, Intermountain Healthcare Murray Utah USA
| | - James F Lloyd
- Department of Informatics Intermountain Medical Center, Intermountain Healthcare Murray Utah USA
| | - Greg L Snow
- Intermountain Statistical Data Center, Intermountain Medical Center Intermountain Healthcare Murray Utah USA
| | - Benjamin D Horne
- Intermountain Medical Center Heart Institute Murray Utah USA.,Division of Cardiovascular Medicine Stanford University Stanford California USA
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Comparative Frequency of Venous Thromboembolism in Patients Admitted to the Hospital with SARS-CoV-2 Infection vs. Community-acquired Pneumonia. Ann Am Thorac Soc 2022; 19:1233-1235. [PMID: 35312468 PMCID: PMC9278635 DOI: 10.1513/annalsats.202108-953rl] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bledsoe JR, Knox D, Peltan ID, Woller SC, Lloyd JF, Snow GL, Horne BD, Connors JM, Kline JA. D-dimer Thresholds to Exclude Pulmonary Embolism among COVID-19 Patients in the Emergency Department: Derivation with Independent Validation. Clin Appl Thromb Hemost 2022; 28:10760296221117997. [PMID: 35942703 PMCID: PMC9373165 DOI: 10.1177/10760296221117997] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To derive and validate a D-dimer cutoff for ruling out pulmonary embolism
(PE) in COVID-19 patients presenting to the emergency department (ED). Methods A retrospective cohort study was performed in an integrated healthcare system
including 22 adult ED's between March 1, 2020, and January 31, 2021. Results
were validated among patients enrolled in the RECOVER Registry, representing
data from 154 ED's from 26 US states. Consecutive ED patients with
laboratory confirmed COVID-19, a D-dimer performed within 48 h of ED
arrival, and with objectively confirmed PE were compared to those without
PE. After identifying a D-dimer threshold at which the 95% confidence lower
bound of the negative predictive value for PE was higher than 98% in the
derivation cohort, it was validated using RECOVER registry data. Results Among 3978 patients with a D-dimer result, 3583 with confirmed COVID-19
infection were included in the derivation cohort. Overall, PE incidence was
4.1% and a D-dimer cutoff of <2 μ/mL (2000 ng/mL)
was associated with a NPV of 98.5% (95% CI = 98.0%−98.9%). In the validation
cohort of 13,091 patients with a D-dimer, 7748 had confirmed COVID-19
infection, and the PE incidence was 1.14%. A D-dimer cutoff of
<2 μ/mL was associated with a NPV of 99.5%
(95% CI = 99.3%−99.7%). Conclusion A D-dimer cutoff of <2 μ/ml was associated with a
high negative predictive value for PE among patients with COVID-19. However,
the resultant sensitivity for PE result at that threshold without pre-test
probability assessment would be considered clinically unsafe.
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Affiliation(s)
- Joseph R Bledsoe
- Department of Emergency Medicine, Intermountain Healthcare, Salt Lake City, UT, USA.,Department of Emergency Medicine, 158423Stanford Medicine, Stanford, CA, USA
| | - Daniel Knox
- Department of Medicine, Division of Pulmonary/Critical Care, Intermountain Medical Center and University of Utah, Salt Lake City, UT, USA
| | - Ithan D Peltan
- Department of Medicine, Division of Pulmonary/Critical Care, Intermountain Medical Center and University of Utah, Salt Lake City, UT, USA
| | - Scott C Woller
- Department of Internal Medicine, Intermountain Medical Center Department of Medicine and University of Utah, Salt Lake City, UT, USA
| | - James F Lloyd
- Medical Informatics and Analytics, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Gregory L Snow
- Intermountain Healthcare, Office of Research, Statistical Data Center, Salt Lake City, UT, USA
| | - Benjamin D Horne
- Intermountain Medical Center Heart Institute, Salt Lake City, UT, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Jean M Connors
- Department of Hematology, Brigham and Womens Hospital, Boston, MA, USA
| | - Jeffrey A Kline
- Department of Emergency Medicine, 12267Wayne State University School of Medicine, Detroit, MI, USA
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Andraska E, Neal M, Handzel R. Utilizing natural language processing in the diagnosis and treatment of venous thromboembolism. Surgery 2021; 170:1183. [PMID: 34325905 DOI: 10.1016/j.surg.2021.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Elizabeth Andraska
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Matthew Neal
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Robert Handzel
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
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Woller SC, Stevens SM, Fazili M, Lloyd JF, Wilson EL, Snow GL, Bledsoe JR, Horne BD. Post-discharge thrombosis and bleeding in medical patients: A novel risk score derived from ubiquitous biomarkers. Res Pract Thromb Haemost 2021; 5:e12560. [PMID: 34263106 PMCID: PMC8265782 DOI: 10.1002/rth2.12560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/20/2021] [Accepted: 05/31/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Some hospitalized medical patients experience venous thromboembolism (VTE) following discharge. Prophylaxis extended beyond hospital discharge (extended duration thromboprophylaxis [EDT]) may reduce this risk. However, EDT is costly and can cause bleeding, so selecting appropriate patients is essential. We formerly reported the performance of a mortality risk prediction score (Intermountain Risk Score [IMRS]) that was minimally predictive of 90-day hospital-associated venous thromboembolism (HA-VTE) and major bleeding (HA-MB). We used the components of the IMRS to calculate de novo risk scores to predict 90-day HA-VTE (HA-VTE IMRS) and major bleeding (HA-MB IMRS). METHODS From 45 669 medical patients we randomly assigned 30 445 to derive the HA-VTE IMRS and the HA-MB IMRS. Backward stepwise regression and bootstrapping identified predictor covariates from the blood count and basic chemistry. These candidate variables were split into quintiles, and the referent quintile was that with the lowest event rate for HA-VTE and HA-MB; respectively. A clinically relevant rate of HA-VTE and HA-MB was used to inform outcome rates. Performance was assessed in the derivation set of 15 224 patients. RESULTS The HA-VTE IMRS and HA-MB IMRS area under the receiver operating curve (AUC) in the derivation set were 0.646, and 0.691, respectively. In the validation set, the HA-VTE IMRS and HA-MB IMRS AUCs were 0.60 and 0.643. CONCLUSIONS Risk scores derived from components of routine labs ubiquitous in clinical care identify patients that are at risk for 90-day postdischarge HA-VTE and major bleeding. This may identify a subset of patients with high HA-VTE risk and low HA-MB risk who may benefit from EDT.
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Affiliation(s)
- Scott C. Woller
- Department of MedicineIntermountain Medical CenterIntermountain HealthcareMurrayUTUSA
- Department of Internal MedicineUniversity of Utah School of MedicineSalt Lake CityUTUSA
| | - Scott M. Stevens
- Department of MedicineIntermountain Medical CenterIntermountain HealthcareMurrayUTUSA
- Department of Internal MedicineUniversity of Utah School of MedicineSalt Lake CityUTUSA
| | - Masarret Fazili
- Department of MedicineIntermountain Medical CenterIntermountain HealthcareMurrayUTUSA
| | - James F. Lloyd
- Department of InformaticsIntermountain Medical CenterIntermountain HealthcareMurrayUTUSA
| | - Emily L. Wilson
- Intermountain Statistical Data CenterIntermountain Medical CenterIntermountain HealthcareMurrayUTUSA
| | - Gregory L. Snow
- Intermountain Statistical Data CenterIntermountain Medical CenterIntermountain HealthcareMurrayUTUSA
| | - Joseph R. Bledsoe
- Department of Emergency MedicineIntermountain Medical CenterIntermountain HealthcareMurrayUTUSA
- Department of Emergency MedicineStanford UniversityStanfordCAUSA
| | - Benjamin D. Horne
- Intermountain Medical Center Heart InstituteMurrayUTUSA
- Division of Cardiovascular MedicineStanford UniversityStanfordCAUSA
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